Family Therapy Billing: 90846 vs 90847 — Who Can Bill and How
A family session gets scheduled, the note gets written, and then the billing question starts — which code, whose insurance, and whether the clinician’s license is even billable under that plan. Family therapy billing trips up practices because three gates all have to open at once: the right CPT code, the right member on the claim, and a clinician the payer recognizes. Miss any one and the claim denies.
This guide walks through the two family psychotherapy codes — 90846 and 90847 — answers the license question practice owners ask most, and covers the payer rules that catch practices off guard. For the full code-by-code reference, see our psychotherapy CPT codes guide.
The two family therapy codes, in brief
- 90846 — family psychotherapy, patient NOT present. A 50-minute session with the patient’s family members or partner, the identified patient absent for the entire encounter.
- 90847 — family psychotherapy (conjoint), patient present. A 50-minute session with the identified patient taking part alongside family or a partner.
The presence of the identified patient decides the code — not the session length, not the topic. “Family” in CPT terms includes couples: couples therapy has no code of its own, so it is reported with 90846 or 90847 depending on whether the identified patient takes part. Both must address the identified patient’s treatment; a general family counseling session unrelated to the patient’s care supports neither.
Who can bill 90846 and 90847?
Two different gates decide whether a clinician’s family therapy services get paid, and both have to be open.
Gate one — license scope
The clinician must be licensed and practicing within scope to bill psychotherapy codes. In practice, family psychotherapy is billed by licensed marriage and family therapists (LMFTs), licensed clinical social workers (LCSWs), licensed mental health counselors or professional counselors (LMHCs/LPCs), licensed psychologists, and psychiatrists or psychiatric nurse practitioners (less common, since their sessions often involve medication management). If family or couples therapy sits inside the clinician’s licensed scope of practice in their state, the codes are available to them — the license is the foundation, not the whole building.
Gate two — plan enrollment and credentialing
Being licensed to provide family therapy is not the same as being able to bill a given plan for it. The rendering clinician has to be credentialed — or enrolled, for government plans — with that plan before the first billable session. A perfectly licensed LMFT whose credentialing lapsed, or who was never rostered with a behavioral health carve-out, will see clean family-therapy claims deny for provider reasons. Check enrollment status before scheduling, not after the denial arrives.
Medicare: the rules that surprise therapy practices
Medicare’s psychotherapy coverage extends to the family codes, but with quirks: coverage and pricing of 90846 in particular can vary by Medicare contractor, so read the contractor’s behavioral health policy before scheduling patient-absent sessions as a standing pattern. One change worth knowing: since 2024, marriage and family therapists and licensed mental health counselors have been able to enroll as Medicare providers — including for the family codes where the contractor’s policy covers them. Confirm the enrollment effective date first; services before it do not pay.
Medicaid and commercial carve-outs
State Medicaid plans vary widely: some cover both codes cleanly, others route behavioral health through a managed-care or carve-out organization with its own credentialing list. The commercial equivalent is the behavioral health carve-out — many employer plans hand mental health benefits to a separate behavioral health organization with its own payer ID and network. Family therapy billed to the medical plan’s payer ID instead of the carve-out’s is a fast, repeatable denial that has nothing to do with coding.
Whose insurance gets billed — the identified patient rule
Every family therapy claim goes under the identified patient’s insurance — their member ID and primary mental health diagnosis — regardless of who attends. Meeting with parents about a child’s treatment? The claim carries the child’s information. Working with a spouse on the patient’s depression? The claim carries the patient’s information.
The common error is billing under the attending family member’s plan because they were the ones in the room. For 90846 especially, this is easy to make and instantly deniable: the diagnosis on the line must belong to the identified patient and must support medical necessity for family psychotherapy.
Choosing between 90846 and 90847
Patient present for all or a meaningful part of the session: report 90847. Patient absent for the entire encounter: report 90846. When one appointment block transitions from family-only to family-plus-patient, report 90847 for the whole encounter; do not split it into two codes.
Two combination rules to respect:
- Do not report 90846 and 90847 for the same date of service for the same encounter. Two genuinely separate, distinct sessions on the same day may qualify under some payer policies, but verify the plan’s rule first — this is a documented unbundling risk.
- Do not pair an individual psychotherapy code (90832/90834/90837) with 90847 for the same time. If the visit was truly family psychotherapy with the patient present, 90847 is the code; if it was individual therapy with a partner briefly invited in, the individual code may be right.
Payer rules that catch practices off guard
Three payer patterns produce most family-therapy denials:
- 90846 coverage varies more by plan than 90847. Some plans treat patient-absent sessions as an auxiliary service: frequency caps, prior-authorization triggers for extended use, or outright exclusion. Read the plan’s behavioral health policy before building a treatment pattern around 90846.
- Carve-outs demand the right payer ID. Confirm which organization administers the patient’s behavioral health benefit — and that the clinician is in that organization’s network — before the first visit. A dedicated eligibility check before the first session exists for exactly this problem.
- Telehealth family sessions need the plan’s telehealth recipe. Same codes as in-person, plus the modifier and place-of-service code the plan requires — and a 90846 delivered by telehealth still needs the identified patient absent and the note showing treatment relevance.
Documentation that defends a family-therapy claim
Family codes draw reviewer attention because the patient is sometimes absent:
- Who attended — names and relationship to the patient.
- Whether the identified patient was present — stated explicitly, not implied.
- How the session addressed the patient’s treatment — goals worked on, interventions used, progress toward the plan of care. For 90846, include the clinical rationale for holding the session without the patient.
- Time — start and stop times or total duration supporting the 50-minute code.
- Diagnosis — the identified patient’s primary mental health diagnosis, consistent with the claim.
Thin notes are why most legitimate family-therapy claims deny: the service happened and the code was right, but nothing on paper ties the session to the identified patient’s treatment. Our breakdown of common psychotherapy claim denials shows how these documentation gaps become denial patterns — and how each one is prevented.
When a family-therapy claim denies — the fix order
- Read the remit’s reason code first — provider/enrollment, coverage, and coding denials each point at a different gate.
- Confirm the code matches attendance in the note — a 90846 with the patient present in the note is a corrected claim, not an appeal.
- Verify the identified patient’s diagnosis is primary on the service line.
- Check the clinician’s credentialing/enrollment with the payer billed — including the carve-out.
- If the service was legitimate and the plan covers it, appeal with the session note attached.
Frequently asked questions
Can an LMFT bill 90847?
Yes — when the LMFT is licensed, practicing within scope, and credentialed or enrolled with the plan being billed. The same applies to LCSWs, LMHCs/LPCs, and psychologists, and since 2024 MFTs can also enroll as Medicare providers. Verify the individual plan’s provider manual, because network rules are set plan by plan.
Can 90846 and 90847 be billed on the same day?
Not for the same encounter. If two genuinely separate, distinct family sessions occurred on the same day, some payer policies allow both — but verify the plan’s rule first, since this is a known unbundling risk.
Whose insurance is billed for a family therapy session?
The identified patient’s — their member ID and primary mental health diagnosis — regardless of who attends. Billing under an attending family member’s plan will deny.
Does couples therapy have its own CPT code?
No. Couples work is reported as family psychotherapy: 90847 when the identified patient takes part, 90846 when they do not, with the claim under the identified partner’s insurance and diagnosis.
Is 90846 covered the same way as 90847?
No — coverage of 90846 varies more between plans. Some payers cap how often it can be used or require authorization for extended use, and Medicare contractor rules can differ. Verify the plan’s behavioral health policy before scheduling patient-absent sessions.
Conclusion
Family therapy billing is three decisions in one: the right code for who was in the room, the identified patient’s insurance on the claim, and a clinician the payer recognizes through active credentialing. Practices that check all three before the session keep family-therapy claims out of the denial queue.
If coding reviews, denial patterns, or credentialing backlogs are eating into your week, Fastora’s behavioral health billing team handles the full revenue cycle for therapy practices. A free billing assessment will show exactly where your family-therapy claims are leaking before you commit to anything.
